Injection devices that provide reduced outflow of therapeutic agents and methods of delivering therapeutic agents

ABSTRACT

Injection devices are provided, which reduce potential outflow of therapeutic agents from an injection site. Devices are provided having at least a first lumen containing one or more therapeutic agents and a second lumen containing a second material for injection into tissue. Other devices are provided having an inner lumen with an injection needle to inject a therapeutic agent and an outer lumen that provides a vacuum seal between the injection needle and the needle track. Further provided are methods of delivering a therapeutic agent to tissue.

RELATED APPLICATION

This application is a Continuation of U.S. application Ser. No.10/215,034, filed on Aug. 9, 2002, incorporated herein in its entirety.

FIELD OF THE INVENTION

The present invention relates to injection devices that provide reducedleakage of therapeutic agents from an injection site resulting inincreased agent uptake. According to embodiments of the presentinvention injection devices are provided having at least two lumenscontaining one or more therapeutic agents in at least one lumen and atleast a second material for injection in at least one other lumen. Otherembodiments include injection devices having at least one lumencontaining one or more therapeutic agents and an outer lumen adapted toprovide a vacuum seal between an injection needle and the needle trackit creates.

The present invention also relates to methods for delivering therapeuticagents to a tissue. Embodiments of the present invention includeinjecting at least one therapeutic agent into tissue and injecting atleast one second material to the tissue. Other embodiments includecreating a vacuum between an injection needle and the needle track itcreates to reduce potential leakage of the therapeutic agent.

BACKGROUND OF THE INVENTION

The treatment of disease such as vascular disease by localpharmacotherapy presents a means of delivering therapeutic drug doses totarget tissues while minimizing systemic side effects. Such localizeddelivery of therapeutic agents has been proposed or achieved usingmedical devices such as catheters, needle devices and various coatedimplantable devices such as stents.

The localized delivery of therapeutic agents using needle devices hasthe advantages of precise placement and accurate control over the volumeand rate of delivery. However, delivery using needle devices creates aneedle track, which allows leakage or outflow of the therapeutic agent.

SUMMARY OF THE INVENTION

Embodiments of the present invention include injection devices thatinclude at least a first lumen containing at least one therapeutic agentfor injection into a tissue and a second lumen containing at least asecond material for injection into the tissue. The depth and deploymentof each lumen into tissue is controlled together or preferablyindependently from one another. The injection device optionally includesa third lumen containing a third material for injection into thematerial.

In other embodiments, the present invention includes injection devicesthat include an injection needle at a distal end of an inner lumenadapted to inject one or more therapeutic agents into tissue, an outerlumen adapted to provide a vacuum seal between the injection needle anda needle track it creates, and a vacuum-creating device for creating avacuum in the outer lumen. These devices optionally include one or moregaskets to aid in forming the seal.

In other embodiments, the invention includes methods of delivering oneor more therapeutic agents to tissue with an injection device. Thesemethods include injecting at least one therapeutic agent into tissue,preferably tissue of a mammal, from a first lumen of an injection deviceand injecting at least one second material into the tissue from a secondlumen of the injection device. The second material may be injectedafter, before, or substantially concurrently with injection of thetherapeutic agent. The composition and amount of the second material andtiming of its injection with respect to the injection of the therapeuticagent, are selected so as to reduce leakage of the therapeutic agent(s)from the injection site.

Further embodiments of the present invention include other methods ofdelivering therapeutic agent(s) to tissue. These methods includedeploying a needle from a needle injection device at the distal end ofan inner lumen into tissue, thus forming a needle track; establishing avacuum in an outer lumen of the injection device to create a vacuum sealbetween the needle track and the needle; injecting at least onetherapeutic agent into tissue from the inner lumen; and releasing thevacuum seal.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts an injection device according to the present inventionhaving a first lumen 1 containing at least one therapeutic agent and asecond lumen 2 containing at least one second material outside the firstlumen.

FIG. 2 depicts an injection device according to the present inventionhaving a third lumen containing a third material for injection, wherethe second material and third material combine to form a plug 4.

FIG. 3 depicts another injection device according to the presentinvention. In this embodiment the second material is relatively viscousand provides resistance to outflow of therapeutic agent.

FIG. 4 depicts the injection device of FIG. 3 having a second material 5blocking outflow of therapeutic agent.

FIG. 5 depicts an injection device according to the present inventionhaving an inner lumen 8 that contains therapeutic agent and an outerlumen 6 through which a vacuum may be formed. This embodiment also hasgaskets 7.

FIG. 6 is a sectional view of another embodiment of the invention. Inthis embodiment the walls of the outer lumen 6 have openings 16 toprovide communication between the negative pressure created in the outerlumen and the needle track.

FIG. 7 shows a portion of the injection device of FIG. 6. This viewshows the openings as being holes aligned substantiallycircumferentially, and further shows gaskets on two sides of the holes.

FIG. 8 is a sectional view of a catheter of the injection device (as inFIG. 6) meeting up with and being attached to a handle designed so as tocreate and maintain a negative pressure in the outer lumen of the devicewith a plunger 20 and ratchet 22.

DETAILED DESCRIPTION

When therapeutic agents are delivered to target tissue with an injectiondevice such as a needle, leaking and dispersion often result uponremoval of the device from the tissue. For example, a needle track isformed in tissue after a therapeutic agent has been injected into atissue with an injection device and subsequently removed from thetissue. Therefore, where an injection is performed via a needle, thereis potential for leakage of the administered therapeutic agent along theneedle track left by needle withdrawal.

This problem is exacerbated in situations where the therapeutic agent isinjected into the tissue of an organ that undergoes expansion andcontraction, such as the heart. In such cases, the organ wall thinsduring organ expansion, thus facilitating the leakage ofpreviously-injected therapeutic agent from the organ tissue through theneedle track and thereby decreasing the actual dose of therapeutic agentdelivered to the target site and increasing systemic distribution of thedrug. Thus, the efficiency of endocardial injection devices, forexample, to deliver therapeutic agents to treat heart disease, inparticular, is limited by poor retention of the therapeutic agent withintissue. As an example of the problem, it is estimated that less than 10%of cells delivered through endocardial injections are retained.

The present invention decreases the potential leakage of therapeuticagent by providing injection devices and methods that inhibit loss ofinjected therapeutic agent.

Injection Devices

The present invention relates to injection devices that provide reducedleakage of therapeutic agents from an injection site preferablyresulting in increased efficiency or agent uptake.

The invention is described herein with specific reference to aninjection needle as the injection device. Examples of specific devicesincorporating injection needles, and thus within the scope of theinvention, include needle injection catheters, hypodermic needles,biopsy needles, ablation catheters, cannulas and any other type ofmedically useful needle. It will be understood by one of ordinary skillin the art that other injection devices are contemplated and are withinthe scope of the invention. Specifically, any device competent topenetrate or separate tissue is contemplated, particularly those thatcreate an opening through which a delivered agent may escape or “leakout,” including for example, a lumen in the device with walls that areshaped such that it can penetrate or separate tissue. Non-needleinjection devices are also contemplated by the present invention.Examples of non-needle injection devices include, but are not limitedto, transmural myocardial revascularization (TMR) devices andpercutaneous myocardial revascularization (PMR) devices or any otherdevice capable of wounding or creating a channel or crater in tissue.Further examples of suitable injection devices include ablation devicesand needle-free injectors which propel fluid using a spring orpressurized gas, such as carbon dioxide injection devices.

According to embodiments of the present invention, the injection devicesinclude at least two lumens. One or more therapeutic agents is containedin at least one lumen and at least a second material for injection in atleast one other lumen.

The term “therapeutic agent” as used herein includes one or more“therapeutic agents” or “drugs.” The terms “therapeutic agents” and“drugs” are used interchangeably herein and include pharmaceuticallyactive compounds, nucleic acids with and without carrier vectors such aslipids, compacting agents (such as histones), virus (such as adenovirus,adeno-associated virus, retrovirus, lentivirus and a-virus), polymers,hyaluronic acid, gene therapies, proteins, cells, stem cells and thelike, or combinations thereof, with or without targeting sequences. Theinjection administered in accordance with the invention includes thetherapeutic agent(s) and solutions thereof.

Specific examples of therapeutic agents used in conjunction with thepresent invention include, for example, pharmaceutically activecompounds, proteins, cells, stem cells, oligonucleotides, ribozymes,anti-sense oligonucleotides, DNA compacting agents, gene/vector systems(i.e., any vehicle that allows for the uptake and expression of nucleicacids), nucleic acids (including, for example, recombinant nucleicacids; naked DNA, cDNA, RNA; genomic DNA, cDNA or RNA in anon-infectious vector or in a viral vector and which further may haveattached peptide targeting sequences; antisense nucleic acid (RNA orDNA); and DNA chimeras which include gene sequences and encoding forferry proteins such as membrane translocating sequences (“MTS”) andherpes simplex virus-1 (“VP22”)), and viral liposomes and cationic andanionic polymers and neutral polymers that are selected from a number oftypes depending on the desired application. Non-limiting examples ofvirus vectors or vectors derived from viral sources include adenoviralvectors, herpes simplex vectors, papilloma vectors, adeno-associatedvectors, retroviral vectors, and the like. Non-limiting examples ofbiologically active solutes include anti-thrombogenic agents such asheparin, heparin derivatives, urokinase, and PPACK (dextrophenylalanineproline arginine chloromethylketone); antioxidants such as probucol andretinoic acid; angiogenic and anti-angiogenic agents and factors; agentsblocking smooth muscle cell proliferation such as rapamycin,angiopeptin, and monoclonal antibodies capable of blocking smooth musclecell proliferation; anti-inflammatory agents such as dexamethasone,prednisolone, corticosterone, budesonide, estrogen, sulfasalazine,acetyl salicylic acid, and mesalamine; calcium entry blockers such asverapamil, diltiazem and nifedipine;antineoplastic/antiproliferative/anti-mitotic agents such as paclitaxel,5-fluorouracil, methotrexate, doxorubicin, daunorubicin, cyclosporine,cisplatin, vinblastine, vincristine, epothilones, endostatin,angiostatin and thymidine kinase inhibitors; antimicrobials such astriclosan, cephalosporins, aminoglycosides, and nitrofurantoin;anesthetic agents such as lidocaine, bupivacaine, and ropivacaine;nitric oxide (NO) donors such as linsidomine, molsidomine, L-arginine,NO-protein adducts, NO-carbohydrate adducts, polymeric or oligomeric NOadducts; anti-coagulants such as D-Phe-Pro-Arg chloromethyl ketone, anRGD peptide-containing compound, heparin, antithrombin compounds,platelet receptor antagonists, anti-thrombin antibodies, anti-plateletreceptor antibodies, enoxaparin, hirudin, Warfarin sodium, Dicumarol,aspirin, prostaglandin inhibitors, platelet inhibitors and tickantiplatelet factors; vascular cell growth promoters such as growthfactors, growth factor receptor antagonists, transcriptional activators,and translational promoters; vascular cell growth inhibitors such asgrowth factor inhibitors, growth factor receptor antagonists,transcriptional repressors, translational repressors, replicationinhibitors, inhibitory antibodies, antibodies directed against growthfactors, bifunctional molecules consisting of a growth factor and acytotoxin, bifunctional molecules consisting of an antibody and acytotoxin; cholesterol-lowering agents; vasodilating agents; agentswhich interfere with endogenous vascoactive mechanisms; survival geneswhich protect against cell death, such as anti-apoptotic Bcl-2 familyfactors and Akt kinase; and combinations thereof. Cells can be of humanorigin (autologous or allogenic) or from an animal source (xenogeneic),genetically engineered if desired to deliver proteins of interest at theinjection site. The delivery mediated is formulated as needed tomaintain cell function and viability. Any modifications are routinelymade by one skilled in the art.

Polynucleotide sequences useful in practice of the invention include DNAor RNA sequences having a therapeutic effect after being taken up by acell. Examples of therapeutic polynucleotides include anti-sense DNA andRNA; DNA coding for an anti-sense RNA; or DNA coding for tRNA or rRNA toreplace defective or deficient endogenous molecules. The polynucleotidesof the invention can also code for therapeutic proteins or polypeptides.A polypeptide is understood to be any translation product of apolynucleotide regardless of size, and whether glycosylated or not.Therapeutic proteins and polypeptides include as a primary example,those proteins or polypeptides that can compensate for defective ordeficient species in an animal, or those that act through toxic effectsto limit or remove harmful cells from the body. In addition, thepolypeptides or proteins that can be injected, or whose DNA can beincorporated, include without limitation, angiogenic factors and othermolecules competent to induce angiogenesis, including acidic and basicfibroblast growth factors, vascular endothelial growth factor, hif-1,epidermal growth factor, transforming growth factor α and β,platelet-derived endothelial growth factor, platelet-derived growthfactor, tumor necrosis factor α, hepatocyte growth factor and insulinlike growth factor; growth factors; cell cycle inhibitors including CDKinhibitors; anti-restenosis agents, including p15, p16, p18, p19, p21,p27, p53, p57, Rb, nFkB and E2F decoys, thymidine kinase (“TK”) andcombinations thereof and other agents useful for interfering with cellproliferation, including agents for treating malignancies; andcombinations thereof. Still other useful factors, which can be providedas polypeptides or as DNA encoding these polypeptides, include monocytechemoattractant protein (“MCP-1”), and the family of bone morphogenicproteins (“BMP's”). The known proteins include BMP-2, BMP-3, BMP-4,BMP-5, BMP-6 (Vgr-1), BMP-7 (OP-1), BMP-8, BMP-9, BMP-10, BMP-11,BMP-12, BMP-13, BMP-14, BMP-15, and BMP-16. Currently preferred BMP'sare any of BMP-2, BMP-3, BMP-4, BMP-5, BMP-6 and BMP-7. These dimericproteins can be provided as homodimers, heterodimers, or combinationsthereof, alone or together with other molecules. Alternatively or, inaddition, molecules capable of inducing an upstream or downstream effectof a BMP can be provided. Such molecules include any of the “hedgehog”proteins, or the DNAs encoding them.

Preferred therapeutic agents according to the present invention includeone or more of the following therapeutic agents: cells, stem cells,virus, protein, drug, enzymes, or combinations thereof.

Organs and tissues that may be treated by the methods of the presentinvention or using the injection devices of the present method includeany mammalian tissue or organ, whether injected in vivo or ex vivoNon-limiting examples include heart, lung, brain, liver, skeletalmuscle, smooth muscle, kidney, bladder, intestines, stomach, pancreas,ovary, prostate, eye, tumors, cartilage and bone. Preferably, the tissueis myocardium, tunica media, tunica adventitia, and/or cardiac valvetissue.

The therapeutic agents can be used, for example, in any application fortreating, preventing, or otherwise affecting the course of a disease ortissue or organ dysfunction. For example, the methods of the inventioncan be used to induce or inhibit angiogenesis, as desired, to prevent ortreat restenosis, to treat a cardiomyopathy or other dysfunction of theheart, for treating Parkinson's disease or a stroke or other dysfunctionof the brain, for treating cystic fibrosis or other dysfunction of thelung, for treating or inhibiting malignant cell proliferation, fortreating any malignancy, and for inducing nerve, blood vessel or tissueregeneration in a particular tissue or organ.

Therapeutic agents may be directly injected into tissue, or may bedelivered in a solution or other form and may be delivered via acarrier. Therapeutic agents may be delivered for example viamicrospheres that are injected into the tissue, rather than injectingtherapeutic agents directly into the tissue. In preferred embodiments,therapeutic agents may be injected via microspheres into muscle tissue.Injecting therapeutic agents via microspheres may result in sustainedrelease or delivery of the drug. Direct injection of therapeutic agentsmay represent an effective means to treat the entire myocardium.Injected agents tend to disperse throughout the myocardium intouninjected areas. Thus, the number of injections that is necessary inorder to deliver therapeutic agents to a specific area of tissue may bedecreased.

In preferred embodiments, therapeutic agents are delivered to muscletissue by injecting a therapeutic agent directly into the muscle tissue.In more preferred embodiments, the muscle tissue is heart tissue.

The second material may be any material that when injected into or neara tissue may reduce in any way, outflow of therapeutic agent from aninjection site in tissue. Examples of suitable second materialsaccording to the present invention include, for example phosphatebuffered saline (PBS), ethanol, low molecular weight polyethyleneglycols (PEGs), low concentration protein gels, anionic solutions suchas alginate (with or without CaCl₂), sodium chloride solution,hyaluronan, chitin, and heparin, saline, contrast medium, protein gel,carboxymethycellulose, platelets, potassium metaphosphate polymers,precipitation solutions (such as SAIB), and combinations thereof.

The second material(s) are preferably selected based at least in part ontheir physical, chemical and electrochemical properties. For example,the second material may be viscous, thus providing a physical barrier tooutflow of therapeutic agent or it may be relatively inviscid thus“washing” much of the agent into the tissue. A viscous second materialmay be advantageously delivered before the therapeutic agent isdelivered for example, so that as the therapeutic agent is delivered,much of it is kept from leaking out of the needle track opening by theviscous material. Preferred second materials according to suchembodiments include, for example, low molecular weight PEGs, lowconcentration protein gels, cross-linked alginate gels and combinationsthereof.

In embodiments in which the second material is relatively viscous, thesecond material is preferably delivered before, and preferably proximalto the agent, so there is a resistance to flow out of the needle track.See for example FIG. 3 in which lumen 2 is activated and the secondmaterial is released from the lumen (either into, partially into, oroutside of the tissue). The released second material 5 then providesresistance to outflow of the therapeutic agent from the tissue afterlumen 2 is activated and the therapeutic agent is injected into tissue.As shown in FIGS. 3 and 4, the viscous second material 5 preferablyprovides a resistance to the therapeutic agent flowing back out of theneedle track after it is released from lumen 2.

The second material may act for example as a barrier trapping agent atthe distal end of the needle track, relatively deep within themyocardium. According to these embodiments, the second material ispreferably administered in an amount that may be sacrificially lostthrough back-leakage out the needle track, without substantial loss ofthe therapeutic agent out of the needle track. A preferred secondmaterial according to these embodiments include for example, PBS, lowconcentration protein gels and the like. In addition to improvingretention of the agent, preferably, the second material facilitatestissue penetration and agent distribution, preferably ultimatelyachieving a larger treatment zone than may have been achieved withoutthe second material.

In embodiments in which a second material that is relatively misciblewith the agent, the second material is preferably deliveredsimultaneously with the agent, forcing much of the agent to go andremain relatively deep in the tissue (as compared to the secondmaterial) during delivery.

According to embodiments of the invention, the second materials mayinclude formulations that are substantially immiscible with thetherapeutic bolus. Such materials may be used for example, as drivingforces for therapeutic agent retention and penetration into the tissue.An example of these embodiments includes for example, deliveringnegatively charged plasmid DNA as the therapeutic agent and 10-100×anionic solution, such as alginate, hyaluronan, chitosan, potassiummetaphosphate, glycosaminoglycan solution and the like as the secondmaterial.

The depth and deployment of each lumen into tissue is controlledtogether or independently from one another. Preferably, the depth anddeployment of each lumen is controlled independently from one another.Such a device having independently controlled lumens is preferablycontrolled manually or by some control device, such that one maydetermine which lumen to deploy first, how far into the tissue or awayfrom the tissue the therapeutic agent or second material should beinjected, and the timing of each injection, such as whether to deploythe lumens and inject their contents simultaneously or how soon afterone deployment, the other lumen is deployed. The order, depth and timingof deployment should be determined by those skilled in the art dependingon various factors such as the composition of the therapeutic agents(and/or their carriers) and the second materials (includingconsideration of their physical characteristics, such as their relativeviscosities and miscibility with each other) and the organ beinginjected.

The delivery of the second material may vary spatially or temporallyfrom the delivery of the therapeutic agent as may be determined by oneskilled in the art for any desired purpose, including for example, inorder to improve retention of the therapeutic agent. For example,according to embodiments of the invention, the second material isdelivered proximally to the therapeutic agent, which effectively washesit into the tissue. However, the temporal delivery of the second agentwith respect to the first may be varied.

According to preferred embodiments, at least two lumens extend thelength of a catheter which houses them, and the lumens are controlledmechanically via a proximal handle.

A first lumen may be positioned in any way with respect to the secondlumen and any additional lumens, which could achieve any reduction oftherapeutic agent outflow from an injection site in tissue given certaintherapeutic agents (including the carrier) and second materials. Forexample, according to certain embodiments, the first lumen is within asecond lumen. According to other embodiments the first lumen is adjacentto a second lumen (either contacting each other or not contacting eachother).

FIG. 1 shows a needle injection device according to certain embodimentsof the present invention, which may be used to deliver therapeutic agentto tissue by injecting the therapeutic agent into tissue. According tothese embodiments, one or more therapeutic agents contained within lumen1 are delivered to a tissue when lumen 1 is deployed into the tissue.One or more second materials within lumen 2 are delivered to the tissuewhen lumen 2 is deployed to the tissue. Lumen 2 may be deployed after,before or concurrently with lumen 1.

The injection device optionally includes a third lumen 3 as depicted inFIG. 2 containing a third material for injection into the material. Thethird lumen may be positioned in any way with respect to the first andsecond lumens so as to achieve any reduction in therapeutic outflow. Forexample, the third lumen may be outside the second lumen as shown inFIG. 2 or adjacent to (contacting or not contacting) the second lumen.Preferably, the depth and deployment of the third lumen and any furtherlumens are independently controllable.

The third material may be any material that when injected into or near atissue may reduce in any way, outflow of therapeutic agent from aninjection site in tissue. Examples of suitable third materials accordingto the present invention include, for example crosslinking agents,polymerization initiators, surfactants, gel promoting substances, pHincreasing or decreasing solutions, biologically active molecules, andcombinations thereof. Preferred third materials include, for example,divalent cations, CaCl₂, thrombin, NaCl, potassium metaphosphate, sodiumalginates, fibrin, fibrinogen, and fibronectin.

According to embodiments of the present invention having a third lumen,the third lumen is adapted such that when it is deployed it releases athird material. Preferably the third material comprises a material thatwhen contacted with the second material, the third and second materialinteract to form a plug. For example, as shown in FIG. 2, a second lumen2 is deployed releasing a second material and a third lumen 3 isdeployed releasing a third material, and when the second and thirdmaterials contact one another they form a plug 4, which functions toreduce outflow of the therapeutic agent (injected into tissue when lumen1 is deployed) from the injection site. The plug may be for example,solid or semi-solid and may be formed in the needle track or outside theneedle track, for example around the needle track or in the mouth of theneedle track. Preferably, the therapeutic agent is injected into tissuefirst and thereafter the second and third materials are injected orreleased either simultaneously or one after the other. Alternatively thesecond and third materials are released first to form a plug around theinjection site and then the therapeutic agent is injected. Preferredsecond and third materials according to these embodiments include, forexample alginate solutions, sodium alginate, calcium chloride, divalentcations, platelets and fibrin.

Additional lumens containing for example, therapeutic agents, second,third or further ingredients are contemplated herein.

Flow of the second material into the needle track and the physicalbarrier created by the outer lumen itself preferably also improve theretention of the therapeutic agent in the tissue.

According to other embodiments of the present invention, the injectiondevices are adapted such that the timing of the delivery and the amountand type of therapeutic agent and second material may be selected toimprove retention of therapeutic agent in tissue. According to certainembodiments, the therapeutic agent is delivered in a relativelyconcentrated form and diluted by the second material upon delivery ofthe second material. A gradient of the agent exists with the mostconcentrated form being present furthest from the needle track opening.For example, a concentrated dose of therapeutic agent may be deliveredin a 10 microliter volume followed by a 90 microliter volume of a secondmaterial, such as PBS. As another example, the second material isoptionally immiscible with the therapeutic agent, which may furtherenhance retention of the therapeutic agent in the tissue. For example, aconcentrated bolus of aqueous plasmid DNA may optionally be followedwith a 70% injection of ethanol.

The injection devices of the present invention may optionally includeone or more pressure aprons and/or gaskets that are applied to one ormore of the needle lumens to prevent or reduce loss of the therapeuticagent or second material through the needle track while the needle is inplace.

According other embodiments of the present invention, injection devicesare provided, which include an injection needle 9 (see for example, FIG.5) at a distal end of an inner lumen 8 (which injection needle may be ataper or sharpening at the end of a tube forming the inner lumen)adapted to inject a therapeutic agent into tissue, an outer lumen 6adapted to provide a vacuum seal between an injection needle and theneedle track in tissue formed with the injection needle, and avacuum-creating device (not shown) for creating a vacuum in the outerlumen.

According to these embodiments, therapeutic agent retention in thetissue is preferably improved by using an injection device that forms aseal between the outer surface of the injection needle and the tissue ofthe needle track. The seal is preferably formed by creating a negativepressure by the vacuum-creating device in a channel between one or moreoptional gaskets 7 that enter the needle track. According to theseembodiments, the negative pressure in the second lumen created by thevacuum-creating device, pulls the tissue against the optional gaskets,thus substantially preventing the flow of the agent out of the needletrack.

Suitable gaskets for use in the present invention would be known tothose skilled in the art based on the present disclosure. The gasketsare preferably shaped and positioned on the device so as to improve thevacuum seal that will be formed between the needle and the tissue withinthe needle track. The gaskets may be made into many differentgeometrical shapes. Additionally, one or more gaskets may be integratedproximal or distal to the end of the outer lumen. The gaskets arepreferably positioned on the outer walls of the inner lumen, near or onthe needle portion of the lumen walls.

The gaskets according to the present invention may be a combination oftwo or more materials, which may be determined by those skilled in theart to attain a desired compliance, improve adhesion to the needle,and/or allow for easier penetration of the tissue. Gaskets arepreferably made (at least in part) out of one or more biocompatiblematerials (such as silicone, polyethylene, teflon, PTFE, nylons,urethanes, epoxies, pebax, ABS, and polypropylene), even more preferablyone or more compliant, biocompatible materials. The gaskets preferablyresist shear forces associated with deployment of the needle into themyocardium. Additionally, a metal portion may be incorporated on thedistal end of the gasket to facilitate penetration of the myocardium.Thus, the gaskets may include materials such as metal alloys, such asstainless steel, Nitinol, titanium, cobalt-chromium alloys, and the likeor combinations thereof. The gaskets may be coated with one or morematerials, such as hydrogel, cyano-acrylate or potassium metaphosphatepolymers. According to certain embodiments, the surface of the gasketmay be roughened to improve adhesion.

Embodiments of the present invention include injection devices includingan injection needle at a distal end of an inner lumen, adapted to injectat least one therapeutic agent into tissue; and at least one compliantgasket having a shape and size such that when the gasket is situatedbetween the injection needle and a needle track formed in tissue withthe injection needle, a sufficient seal is formed between the needle andthe needle track that when therapeutic agent is injected into tissue thegasket(s) reduce outflow from the needle track of therapeutic agent. Inthese embodiments, no outer lumen or vacuum-creating device isnecessarily needed to form a seal between the needle and the needletrack, but they are optional to try and form a more effective seal. Inthese embodiments, the non-coring nature of the needle will result in aforce normal to the needle and gasket, thus, compressing the gasket. Amore effective seal may be formed using the injection devices of theseembodiments, by gaskets having a larger outer diameter. However, gasketshaving a smaller diameter may cause less trauma to the tissue.

FIG. 6 depicts embodiments of the present invention in which the wallsof the outer lumen form a tube or other shape that is tapered down atthe end 14 to the inner lumen's outer walls 15 at the distal end.According to these embodiments, openings 16 provide communicationbetween the outer lumen and the needle track (see also FIG. 7).Preferably, openings from the outer lumen to the needle track are formedby a series of holes aligned substantially circumferentially. Even morepreferably, the holes are aligned in a somewhat continuous form and arepositioned relatively distally on the injection device so as to make theouter lumen as stable as possible. Preferably at least one compliantgasket, preferably two compliant gaskets 17 are fixed proximal anddistal to the openings 16. Additionally, preferably the walls of thedistal end of the outer lumen are fixed to the outer surface of theinner lumen. This design allows for added stability of the distal end ofthe outer lumen.

According to these embodiments, the outer lumen preferably continues thelength of the catheter and is connected to a cylindrical chamber 18within a handle 19 as shown for example, in FIG. 8. Preferably the outerlumen 6 is connected to the cylindrical chamber 18. The inner lumen 8continues through the handle 19 and is used to deliver the therapeuticagent. According to this embodiment, a plunger 20 within the chamber, isretracted with a thumb wheel 21 to create a negative pressure within theouter lumen. A ratchet 22 attached to the thumb wheel holds the plungerin place for the user while the agent is delivered through the innerlumen.

The injection devices of the present invention optionally include one ormore pressure aprons. In embodiments having one or more pressure aprons,a small apron is attached to the needle such that as the needle isdeployed the apron presses against and makes a seal within the needletrack. Embodiments having such pressure aprons are particularly usefulfor example when the therapeutic agent (or carrier thereof) is arelatively viscous material.

Preferably, the injection devices of these embodiments of the presentinvention include at least one compliant gasket having a shape and sizesuch that when the gasket is situated between the injection needle andthe needle track and a vacuum is created in the outer lumen by thevacuum-creating device, the vacuum pulls tissue from the needle trackagainst the gaskets, substantially preventing the therapeutic agent fromflowing out of the needle track.

Walls of the outer lumen preferably form a tube that has a tapereddistal end 10. The size and geometry of the outer lumen and its wallsand the gaskets are selected such that they are sufficient to engage aninner wall of the needle track while minimizing additional trauma to thetissue.

The vacuum-creating device may be any suitable device known to thoseskilled in the art as being able to create a vacuum in a lumen, such asa plunger, vacuum pump, syringe, and the like. A non-limiting example ofa vacuum pump that may be suitable for use in accordance with thepresent invention, is an 1180 Gomco suction unit. Preferably, theinjection device of the present invention preferably has a device orportal within a proximal handle, which is used to create a vacuum by onecontrolling the vacuum-creating device.

According to preferred embodiments, injection devices of the presentinvention include an inner lumen adapted to inject a therapeutic agentinto tissue, where walls of the inner lumen form a tube or other shapethat has a tapered or sharpened distal end; an outer lumen adapted toprovide a vacuum seal between the injection needle and a needle track intissue formed with the inner lumen, wherein walls of the outer lumenform a tube or other shape that has a tapered distal end; and avacuum-creating device adapted to create a vacuum in the outer lumen.According to these embodiments, the outer lumen is preferably shorterthan the inner lumen, such that a distal end of the walls of the outerlumen is from about 0.1 mm to about 20 mm, preferably from about 1 mm toabout 10 mm (which distance may vary depending on the tissue to beinjected), from the tapered distal end of the inner lumen tube; and atleast one compliant gasket is attached to an outside wall of the innerlumen. Alternatively, these lumens may also have various cross-sectionsincluding concentric circles and crescent moons.

FIG. 5 shows particularly preferred embodiments of the invention aninjection catheter having a (inner) lumen 8 is within an outer lumen 6,wherein the outer lumen forms a tube having a tapered end 10. Accordingto these embodiments, the outer lumen is shorter in length than theinner lumen, such that the distal end 11 of the outer lumen 6 (of FIG.5) is a relatively short distance for example, from about 0.1 to about20 mm, preferably from about 1 mm to about 10 mm, from the beginning ofthe tapered end 12 of the tube formed by the walls of the inner lumen.At least one tapered, preferably compliant, gasket 7 is attached to theouter wall of the inner lumen 13. According to these preferredembodiments, the proximal end of the gasket is preferably a relativelyshort distance (for example, from about 0.1 to about 5 mm) from the end11 of the outer lumen 6. The distal end of the gasket may preferablysubstantially coincide with the beginning of the tapered end of theinner lumen 12. The device of these embodiments preferably has a handlethat having a port such that a vacuum pump or syringe can be attachedthereto to create a vacuum within the outer lumen. A valve is preferablyincorporated into the port such that once an appropriate vacuum level isestablished, (for example less than 22 in. Hg, more preferably less than25 in. Hg, depending on the altitude and other factors as would beapparent to those skilled in the art), it can be essentially maintainedwithout continued manipulation of the pump or syringe. An embodiment ofthe present invention also preferably includes or is attached to apressure gauge that indicates the level of vacuum within the outerlumen. The gauge may preferably be used to determine when an appropriatevacuum seal has been established and to indicate a failure in the seal.

According to other preferred embodiments, the end of the tapered orsharpened portion 9 or injection needle at the end of the inner lumen isselected or designed such that it will not core the tissue, but ratherseparate it. In particular, in the case injecting therapeutic agent intomyocardium, as the myocardium exerts a force normal to the outer surfaceof the needle, one or more compliant gaskets are compressed and seal themore distal portion of the needle track from the more proximal portion.Deformation of the gasket(s) preferably decrease aspiration of thetherapeutic agent into the outer lumen. Additionally, the normal forceof the myocardium onto the outer surface of the needle or tapered end ofthe inner lumen preferably aid in the formation of the vacuum seal.

Methods of Delivering Therapeutic Agents

Further embodiments of the present invention relate to methods fordelivering therapeutic agents to a tissue.

The present invention includes methods of delivering one or moretherapeutic agents to tissue with an injection device. The methodsinclude injecting a therapeutic agent into tissue, preferably tissue ofa mammal, from a first lumen of an injection device and injecting asecond material into the tissue from a second lumen of the injectiondevice.

According to embodiments of the present invention, the present methodsinclude injecting at least one therapeutic agent into tissue from afirst lumen of an injection device and injecting at least one secondmaterial to the tissue from a second lumen of the injection device.

The therapeutic agent(s) and second material(s) are as described abovewith regard to injection devices of the present invention. The injectiondevice is also preferably an injection device according to theembodiments described above. In particular, as described above, thespatial relationship of the lumens with respect to each other may bevaried. Preferably, the first lumen is within the second lumen asdepicted in FIG. 1. Each lumen may be controlled together orindependently, but preferably independently, as described above.

The tissue to which a therapeutic agent is being delivered according tothe present methods, is also as set forth above. According to preferredembodiments, the methods of the present invention include methods ofdelivering a therapeutic agent to a tissue of a mammal includinginjecting a therapeutic agent into tissue of a mammal in need of thetherapeutic agent from a first lumen of an injection device, andinjecting a second material to the tissue from a second lumen of theinjection device. More preferably, the mammal is a human.

Injecting the second material to a tissue is intended to mean that thesecond material may be injected anywhere near or actually into thetissue. For example the second material may be injected in the tissueitself, proximately to the tissue or near the tissue, but notnecessarily in the tissue. It may also mean that the second material isinjected into a needle track that has already been formed in the tissueby injection of the therapeutic agent. This injection may include anyform of injection via needle or non-needle methods. For example, whenthe second lumen is activated, the second material may be released intoan area near the injection site of therapeutic agent and that would beconsidered “injecting a second material” within the scope of the presentinvention, so long as the step of injecting at least one second materialis performed so as to achieve reduced outflow of the therapeutic agentfrom the tissue into which it is injected.

The second material is injected after, before or substantiallysimultaneously with the injection of the therapeutic agent, depending onvarious factors such as the composition and physical properties of thesecond material and the therapeutic agent, as described above.

According to embodiments of the present invention, the method furtherincludes injecting a third material into a tissue from the third lumenof the injection device. The third lumen and third material may be asset forth above. The third material may be injected before, after orsubstantially simultaneously with the therapeutic agent or the secondmaterial. According to preferred embodiments the third material and thesecond material form a solid or semi-solid plug when they contact oneanother.

Embodiments of the present invention may further include applying apressure apron or gasket to one or more of the lumens, preferably tosubstantially prevent loss of the therapeutic agent through a needletrack in the tissue.

The composition and amount of the second material and timing of itsinjection with respect to the injection of the therapeutic agent, are asdescribed above and selected so as to reduce or preferably eliminateleakage of the therapeutic agent(s) from the injection site.

According to other embodiments of the present invention, methods ofdelivering therapeutic agent to tissue are provided that includecreating a vacuum between an injection needle and the needle track itcreates to avoid leakage of the therapeutic agent from the needle track.Methods according to these embodiments include positioning an injectiondevice adjacent to tissue; deploying a needle at the distal end of theinjection device into the tissue forming a needle track in the tissue;establishing a vacuum in an outer lumen of the injection device tocreate a vacuum seal between the needle track and the needle; injectingat least one therapeutic agent into the tissue from the inner lumen; andreleasing the vacuum seal.

The injection devices, therapeutic agents, tissue to be injected, andother components of these methods are as described above with respect tothe injection devices.

The vacuum may be established in the outer lumen by any method offorming a vacuum known to those skilled in the art. One method ofestablishing a vacuum includes opening a port valve associated with theouter lumen and using a vacuum-creating device to create a negativepressure. According to this method, the valve is then closed to maintainthe vacuum in the outer lumen.

The methods of the present invention optionally include flushing thelumens with saline before deploying the needle into tissue.

The methods may also further include waiting for a period of time, suchas from about 1 second to about 60 seconds, preferably about 2 to about20 seconds, between injecting a therapeutic agent into the tissue andopening the port valve.

The diameter of the outer lumen may be selected such that it is largeenough for vacuum purposes, but small enough to reduce potential traumato the tissue caused by the size of the injection device.

In embodiments where the tissue being injected is myocardium, themyocardium preferably aids in the formation of the vacuum seal. As themyocardium contracts, the tissue forming the needle track pushes againstthe needle. Therefore, if a gap exists between the opening of the outerlumen and the needle track, it may close when the myocardium contracts.The needle track tissue may be caught by the steady flow created by thevacuum-creating device and the seal formed. Additionally, as themyocardium contracts, the needle may move creating trauma to the tissue.The vacuum seal within the needle track according to the methods of thepresent invention is advantageous in that it may act to stabilize theneedle and reduce associated trauma.

Shear thinning and shear thickening are properties of some fluids thatmay be advantageous to the present invention. The fluid can be made moreor less viscous by simply impeding its progress through a lumen—i.e.,increasing friction. High viscosity materials will stay implanted betterthan those with low viscosity.

The methods of the present invention may optionally include other stepsthat may improve the delivery of therapeutic agents to a target sitedepending on various factors including for example, the method beingemployed to deliver the therapeutic agent and second material. Examplesof such steps include keeping the injection device engaged with thetissue for a sufficient period of time after the injection has beencompleted (e.g., about 2 seconds to about 60 seconds) such that thetherapeutic agent is substantially absorbed by the target tissue; usingcryogenic techniques or electrosurgical techniques; and/or using athickening agent, bioadhesive material or sealant.

According to certain embodiments of the invention, a thickening agentmay be added to the therapeutic agent prior to injection, so as toincrease the ability of the therapeutic agent to resist forces tendingto push the therapeutic agent out of the tissue via the needle tracks.

As used herein, “thickening agent” refers to any biocompatible additivethat results in an increased viscosity of the materials being injected.By way of example, suitable thickening agents include albumin, iohexolor other contrast agent, alginates, polyacrylic acid, hyaluronic acid,dextran, collagen, gelatin, polyethylene glycol, poloxamers, chitosan,SAIBER, PEG-PLGA, potassium metaphosphate polymers, and variousbiocompatible polymers.

Suitable biocompatible polymers for use in the present invention arehydrophilic or hydrophobic, and include, but are not limited to,polycarboxylic acids, cellulosic polymers, including cellulose acetateand cellulose nitrate, gelatin, polyvinylpyrrolidone, cross-linkedpolyvinylpyrrolidone, hydrogels, polyanhydrides including maleicanhydride polymers, polyamides, polyvinyl alcohols, copolymers of vinylmonomers such as EVA, polyvinyl ethers, polyvinyl aromatics,polyethylene oxides, glycosaminoglycans, polysaccharides, ethylenevinylacetate, polyesters including polyethylene terephthalate,polyacrylamides, polyethers, polyether sulfone, polycarbonate,polyalkylenes including polypropylene, polyethylene and high molecularweight polyethylene, halogenated polyalkylenes includingpolytetrafluoroethylene, polyurethanes, polyorthoesters, proteins,polypeptides, silicones, siloxane polymers, polylactic acid,polyglycolic acid, polycaprolactone, polyhydroxybutyrate valerate andblends and copolymers thereof as well as other biodegradable,bioabsorbable and biostable polymers and copolymers.

In other embodiments of the present invention, the therapeutic agentand/or the second material or other materials being injected (inembodiments having second or other materials) further includes at leastone bioadhesive material. As used herein, “bioadhesive material” refersto any biocompatible additive that results in an increase of theaffinity of the injected material for tissue. Bioadhesive materials foruse in conjunction with the invention include suitable bioadhesivematerials known to those of ordinary skill in the art. By way ofexample, suitable bioadhesive materials include fibrinogen with orwithout thrombin, fibrin, fibropectin, elastin, laminin,cyano-acrylates, polyacrylic acid, polystyrene, potassium metaphosphatepolymers, alginates, SAIBER, bioabsorbable and biostable polymersderivatized with sticky molecules such as arginine, glycine, andaspartic acid, and copolymers.

In other embodiments of the present invention, the method of the presentinvention further includes delivering at least one tissue sealant tosubstantially seal the mouth of the needle track upon needle removal.The sealant is delivered to the mouth of the needle track by anysuitable means, such as through a lumen of a multi-lumen catheter, inwhich case the therapeutic agent is preferably delivered via a separatelumen. Alternatively, for example, the sealant may be added to thetherapeutic agent being injected (or second or additional materials inembodiments containing such materials), or may be coated onto theexterior of the needle.

Such tissue sealants preferably include those having suitable bondingproperties, elasticity and biodegradability for the tissue to which thesealant is to be applied. By way of example, suitable sealants includecyanoacrylates, collagen, fibrinogen with or without thrombin, fibrin,fibrin glue, fibropectin, elastin, laminin, cyano-acrylates, polyacrylicacid, polystyrene, potassium metaphosphate polymers, alginates, SAIBER,bioabsorbable and biostable polymers derivatized with sticky moleculessuch as arginine, glycine, and aspartic acid, and copolymers.

According to other embodiments of the present invention, at least one ofthe methods described above further includes sealing the injection siteby performing radio frequency cautery at the mouth of the needle trackto seal the mouth upon needle removal from the tissue. Cauterizationinvolves using such intense heat to seal the open ends of the tissue.Radio frequency cautery may be performed by any suitable method.

According to other embodiments of the present invention, the presentmethods further include using resistance heating at the mouth of theneedle track. Intense heat may be used to seal the mouth of the needletrack upon needle removal. Intense heat used to seal open ends of tissuemay be generated by a variety of different methods. In preferredembodiments, intense heat is generated by resistance heating a metallicprobe, such that the generated heat is intense enough to seal the openends of tissue.

The present methods may optionally include performing laser heating atthe mouth of the needle track to seal the mouth upon needle removal tofurther inhibit outflow of the therapeutic agent. In these embodiments,laser emitted optical energy may be used to heat biological tissue to adegree suitable for denaturing the tissue proteins such that thecollagenous elements of the tissue form a “biological glue” to seal thetissue.

According to other embodiments, the present methods optionally includeplugging the mouth of a needle track with a solid plug or by coagulatingone or more materials at the mouth upon needle removal. Examples ofmaterials that may be used in accordance with these embodiments in orderto seal the mouth of the needle track include fibrin glue,cyanoacrylate-based adhesives and the like. Other suitable sealant plugswould be apparent to those in the art based on the present disclosure.In preferred embodiments, the sealant plug may be heated (or cooled,depending on the temperature at which the material being used is liquid)prior to application to the mouth of the needle track, and subsequentcooling (or heating) may aid in solidifying and sealing the tissue. Forexample, a temperature sensitive polymer, which is liquid at above orbelow physiological temperature (i.e., about 37° C.) and solidifies atphysiological temperature may be used in these embodiments. Examples ofsuitable materials for use in these embodiments includeN-isoproylacrylamide and certain celluloses.

According other embodiments, the present methods optionally includeapplying a coagulating material to the mouth of the injection site whilethe material is in a first fluent state. Then the material is maintainedin a position so as to plug the mouth of the injection site underconditions which convert the material in situ into a second less-fluentor essentially non-fluent state. The conversion may be achieved eitherby changing the environment surrounding the material by the addition orremoval of chemicals or energy, or by passive means such as maintainingthe material at the normal internal body temperature of a patient. Thetransition of the state of the material from a fluent state to a lessfluent or essentially non-fluent state may be the result of a phasechange or of a viscosity change or of polymerization.

Preferably the material of these embodiments is one or morebiocompatible materials. In preferred embodiments the material is apolymeric material, which can be applied as polymers, monomers,macromers or combinations thereof. The polymeric materials arepreferably those materials that can be polymerized or have theirviscosity altered in vivo, preferably by the application of light,ultrasound, radiation or chelation, alone or in the presence of addedcatalyst or by a change to physiological pH, by solvent dispersivesystems, such as SAIBER and PEG-PLGA, diffusion of calcium ions(alginate) or borate ions (polyvinyl alcohol) into the polymer, orchange in temperature to body temperature.

Examples of polymers that may be suitable for use in these embodimentsinclude those polymers listed above as being suitable thickening agents.Examples of in situ polymerization include, but are not limited to,alginates crosslinked with multivalent cations, fibrinogen crosslinkedwith thrombin and photochemical crosslinking. Further examples ofsuitable polymers include the following. Materials which polymerize oralter viscosity as a function of temperature include poly(oxyalkene)polymers and copolymers such as poly(ethylene oxide)-poly(propyleneoxide) (PEO-PPO) copolymers, and copolymers and blends of these polymerswith polymers such as poly(alpha-hydroxy) acids, including but notlimited to lactic, glycolic and hydroxybutyric acids, polycaprolactones,and polyvalerolactones. Examples of materials which polymerize in thepresence of divalent ions such as calcium, barium, magnesium, copper,and iron include naturally occurring polymers collagen, fibrin, elastin,agarose, agar, polysaccharides such as hyaluronic acid, hyalobiuronicacid, heparin, cellulose, alginate, curdlan, chitin and chitosan, andderivatives thereof, cellulose acetate, carboxymethyl cellulose,hydroxymethyl cellulose, cellulose sulfate sodium salt, andethylcellulose. Examples of materials that can be crosslinkedphotochemically with ultrasound or with radiation generally includethose materials that contain a double bond or a triple bond; examplesinclude monomers which are polymerized into poly(acrylic acids),poly(acrylates), polyacrylamides, polyinyl alcohols, polyethyleneglycols, and ethylene vinyl acetates. Examples of materials that can becrosslinked by the addition of covalent crosslinking agents, such asglutaraldehyde, succindialdehyde or carbodiimide, include aminocontaining polymers including polypeptides and proteins such as albuminand polyethyleneimine.

Alternatively, a non-polymeric coagulant may be used, wherein thenon-polymeric material is capable of transforming into a substantiallysolid matrix in situ is either added to the therapeutic agent prior toinjection or applied to the mouth of a needle track after a needle isremoved from tissue.

The non-polymeric material in these embodiments may optionally becombined with at least one organic solvent. Suitable organic solventsinclude those that are biocompatible, pharmaceutically-acceptable, andwill at least partially dissolve the non-polymeric material. The organicsolvent has a solubility in water ranging from miscible to dispersible.The solvent is capable of diffusing, dispersing, or leaching from thecomposition in situ into aqueous tissue fluid of the implant site suchas blood serum, lymph, cerebral spinal fluid (CSF), saliva, and thelike. Solvents that are useful include, for example, substitutedheterocyclic compounds such as N-methyl-2-pyrrolidone (NMP) and2-pyrrolidone (2-pyrol); esters of carbonic acid and alkyl alcohols suchas propylene carbonate, ethylene carbonate and dimethyl carbonate; fattyacids such as acetic acid, lactic acid and heptanoic acid; alkyl estersof mono-, di-, and tricarboxylic acids such as 2-ethyoxyethyl acetate,ethyl acetate, methyl acetate, ethyl lactate, ethyl butyrate, diethylmalonate, diethyl glutonate, tributyl citrate, diethyl succinate,tributyrin, isopropyl myristate, dimethyl adipate, dimethyl succinate,dimethyl oxalate, dimethyl citrate, triethyl citrate, acetyl tributylcitrate, glyceryl triacetate; alkyl ketones such as acetone and methylethyl ketone; ether alcohols such as 2-ethoxyethanol, ethylene glycoldimethyl ether, glycofurol and glycerol formal; alcohols such as ethanoland propanol; polyhydroxy alcohols such as propylene glycol,polyethylene glycol (PEG), glycerin (glycerol), 1,3-butyleneglycol, andisopropylidene glycol; dialkylamides such as dimethylformamide anddimethylacetamide; dimethylsulfoxide (DMSO) and dimethylsulfone;tetrahydrofuran; lactones such as e-caprolactone and butyrolactone;cyclic alkyl amides such as caprolactam; aromatic amides such asN,N-dimethyl-m-toluamide, and 1-dodecylazacycloheptan-2-one; and thelike; and mixtures and combinations thereof. Preferred solvents includeN-methyl-2-pyrrolidone, 2-pyrrolidone, dimethylsulfoxide, ethyl lactate,propylene carbonate, glycofurol, glycerol, and isopropylidene glycol.Preferably the organic solvent is biocompatible and non-toxic.

A composition of the non-polymeric material is preferably flowable witha consistency that ranges from watery to slightly viscous to a putty orpaste. The non-polymeric material eventually coagulates to amicroporous, solid matrix upon the dissipation of the organic solventinto adjacent tissue fluids. The non-polymeric composition can bemanipulated and shaped within the defect site as it solidifies.Advantageously, the moldability of the composition as it hardens allowsit to conform to irregularities, crevices, cracks, holes, and the like,in the implant site. The resulting substantially solid matrix ispreferably biodegradable, bioabsorbable, and/or bioerodible, and will begradually absorbed into the surrounding tissue fluids, and becomedisintegrated through enzymatic, chemical and/or cellular hydrolyticaction. The term “biodegradable” means that the non-polymeric materialand/or matrix of the implant will degrade over time by the action ofenzymes, by simple or enzymatically catalyzed hydrolytic action and/orby other similar mechanisms in the human body. The term “bioerodible”means that the implant matrix will erode or degrade over time due, atleast in part, to contact with substances found in the surroundingtissue fluids, cellular action, and the like. By “bioabsorbable,” it ismeant that the non-polymeric matrix will be broken down and absorbedwithin the human body, for example, by a cell, a tissue, and the like.

Optionally, the composition of non-polymeric material of theseembodiments can be combined with a minor amount of a biodegradable,bioabsorbable thermoplastic polymer such as a polylactide,polycaprolactone, polyglycolide, or copolymer thereof, to provide a morecoherent solid implant or a composition with greater viscosity so as tohold it in place while it solidifies. The non-polymeric materials arealso capable of coagulating or solidifying to form a solid implantmatrix upon the dissipation, disbursement or leaching of the solventcomponent from the composition and contact of the non-polymeric materialwith an aqueous medium. The solid matrix has a firm consistency rangingfrom gelatinous to impressionable and moldable, to a hard, dense solid.

Non-polymeric materials according to these embodiments that are suitablefor use in the present invention generally include any having theforegoing characteristics. Examples of useful non-polymeric materialsinclude sterols such as cholesterol, stigmasterol, β-sitosterol, andestradiol; cholesteryl esters such as cholesteryl stearate; C₁₂-C₂₄fatty acids such as lauric acid, myristic acid, palmitic acid, stearicacid, arachidic acid, behenic acid, and lignoceric acid; C₁₈-C₃₆ mono-,di- and triacylglycerides such as glyceryl monooleate, glycerylmonolinoleate, glyceryl monolaurate, glyceryl monodocosanoate, glycerylmonomyristate, glyceryl monodicenoate, glyceryl dipalmitate, glyceryldidocosanoate, glyceryl dimyristate, glyceryl didecenoate, glyceryltridocosanoate, glyceryl trimyristate, glyceryl tridecenoate, glyceroltristearate and mixtures thereof; sucrose fatty acid esters such assucrose distearate and sucrose palmitate; sorbitan fatty acid esterssuch as sorbitan monostearate, sorbitan monopalmitate and sorbitantristearate; C₁₆-C₁₈ fatty alcohols such as cetyl alcohol, myristylalcohol, stearyl alcohol, and cetostearyl alcohol; esters of fattyalcohols and fatty acids such as cetyl palmitate and cetearyl palmitate;anhydrides of fatty acids such as stearic anhydride; phospholipidsincluding phosphatidylcholine (lecithin), phosphatidylserine,phosphatidylethanolamine, phosphatidylinositol, and lysoderivativesthereof; sphingosine and derivatives thereof; spingomyelins such asstearyl, palmitoyl, and tricosanyl spingomyelins; ceramides such asstearyl and palmitoyl ceramides; glycosphingolipids; lanolin and lanolinalcohols; and combinations and mixtures thereof. Preferred non-polymericmaterials include cholesterol, glyceryl monostearate, glyceroltristearate, stearic acid, stearic anhydride, glyceryl monooleate,glyceryl monolinoleate, and acetylated monoglycerides.

Any of the above-described second materials, thickening agents,bioadhesive materials, tissue sealants, solid plugs, or coagulants(including polymeric and non-polymeric coagulants), or compositionscontaining any of the above, may contain one or more additives.

The present invention will now be described in detail with respect toshowing how certain specific representative embodiments of the needlesand methods of the present invention, the apparatus components andprocess steps being understood as examples that are intended to beillustrative only. In particular, the invention is not intended to belimited to the physical orientation of injection device components,order of the steps and the like specifically recited herein.

EXAMPLE B 1

An injection device is provided according to the present inventionhaving an injection needle at a distal end of an inner lumen, adapted toinject at least one therapeutic agent into tissue, an outer lumenadapted to provide a vacuum seal between the injection needle and aneedle track in tissue formed with the injection needle, and avacuum-creating device for creating a vacuum in the outer lumen. Theinjection device further includes at least one compliant gasket.

Prior to use, both lumens of the device are flushed with saline. Theinjection needle is deployed once the distal end of the catheter ispositioned substantially perpendicular to and in contact withendocardial wall. The port valve of the device is opened and a pump isused to establish a negative pressure in the outer lumen and a vacuumseal between the needle and the needle track it created upon deploymentof the injection needle. A pressure gauge is used to determine when anappropriate seal is established. The injection device is moved slightlyto aid in forming the seal.

The therapeutic agent is then injected into the tissue. The port valveis then opened, releasing the vacuum seal and the needle is retracted.The injection device is then repositioned for subsequent injections intoa different position of the myocardium tissue.

While the present invention is described with respect to particularexamples and preferred embodiments, it is understood that the presentinvention is not limited to these examples and embodiments. Inparticular, the present invention is not limited to the physicalcomponents of the injection devices listed herein so long as theycontain at least two lumens where the second lumen is adapted to releasea second material or the second lumen is adapted so as to create avacuum, such that outflow of therapeutic agent from a needle track isreduced. Additionally, the types of therapeutic agents and secondmaterials and the orientation and deployment of the lumens are notintended to be limited by the present examples.

Moreover, the present invention is not limited to the method stepsrecited herein and may contain additional steps, such as deployingadditional lumens or adding additional ingredients to the therapeuticagent or other materials, as would be apparent to those skilled in theart based on the present disclosure so as to reduce outflow oftherapeutic agent from tissue. Additionally, the present invention isnot limited to the sequence of the method steps. In particular,different lumens may be deployed or activated at different timesdepending for example, on what material or agent is being deployed orinjected or whether a vacuum is being created.

1. A therapeutic delivery system comprising: a first lumen having aproximal end and a distal orifice; a second lumen having a proximal endand a distal orifice; and a third lumen having a proximal end and adistal orifice, the first lumen slidable relative to the second lumen,the second lumen slidable relative to the first lumen, and the thirdlumen slidable relative to the second lumen.
 2. The system of claim 1wherein the first lumen is within the second lumen.
 3. The system ofclaim 1 wherein the second lumen is within the third lumen.
 4. Thesystem of claim 2 wherein the first lumen is within the third lumen. 5.The system of claim 1 wherein the first lumen contains a firsttherapeutic agent and the second lumen contains a first material forejection from the lumen.
 6. The system of claim 5 wherein the thirdlumen contains a second material, the second material and first materialwhen interfaced forming a plug.
 7. The system of claim 5 wherein thefirst material is immiscible with the first therapeutic agent.
 8. Thesystem of claim 1 wherein the movement of the distal orifice of each ofthe three lumens is controlled independently from one another.
 9. Thesystem of claim 1 wherein at least one of the distal orifices has apiercing tip.
 10. The system of claim 5 wherein the second materialcomprises a biological glue.
 11. The system of claim 5 wherein thesecond material comprises a therapeutic barrier trapping agent.
 12. Thesystem of claim 1 wherein the first lumen contains a first material andthe second lumen contains a second material and the third lumen containsa third material and wherein the first material and the second materialand the third material are different from one another.
 13. A therapeuticdelivery system comprising: a first lumen having a proximal end and adistal therapeutic delivery end; and a lumen set having an inner lumenand an outer lumen, the inner lumen having a distal orifice and theouter lumen having a distal orifice, the first lumen slidable relativeto the inner lumen, the first lumen positioned within the inner lumen,the distal therapeutic delivery end of the first lumen extendible pastthe distal orifice of the outer lumen, the distal orifice of the outerlumen in fluid communication with an outside surface of the first lumenwhen the delivery end of the first lumen is extending past the distalorifice of the outer lumen, the distal therapeutic delivery end of thefirst lumen having a piercing portion.
 14. The therapeutic deliverysystem of claim 13 wherein at least one lumen in the lumen set containsa biological glue.
 15. The therapeutic delivery system of claim 14wherein at least one lumen in the lumen set contains a therapeuticbarrier trapping agent.